Organ and Tissue Donation in Brazil

Transcrição

Eduardo Rocha, MD, PhD
Latin America Countries
Latin America
Population: > 570.000.000
GDP: 4.26 trillion U$
Spanish language
Deceased Organ Donation in Latin America
Country
Donation rate
Country
Donation rate
Argentina
12.5
Guatemala
0.2
Bolivia
2.0
Honduras
N.A.
Brazil
8.7
Mexico
3.1
Chile
7.1
Panama
3.3
Colombia
12.3
Paraguay
N.A.
Costa Rica
7.7
Peru
1.3
Cuba
16.6
Puerto Rico*
26.3
Dominican
Republic
0.8
Trinidad &
Tobago
0.8
Ecuador
1.2
Uruguay
19.4
El Salvador
N.A.
Venezuela
3.2
Source: IRODaT, 2010
Organ donation in Latin America (p.m.p.)
Source: IRODAT - 2009
Deceased organ donation (pmp) 2009
IRODaT
40
35
34,4
31
30
25,4 24,6
24
25
21,3 21,1
20
20 19,4 19,1
18,8
17,6 17,4
16,5
15
15,5 14,9 14,8 14,7
13,9 13,8 13,3
11,5 11,4 11,3 11
10
10
8,7
4,6
5
3,3 2,9
1,4 0,8
0,5
Ge UK
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Figure 1: Organ Deceased Donors: DBD + DCD, 2009. Numbers in pmp (per million of population)
www.tpm.org
BRASIL vs. EUROPE
BRAZIL
•
•
•
•
•
•
Largest country in Latin America
5th largest country in the world (3.287 Mi2)
Population: 190,732,696 (2010 census)
Official language: Portuguese
GDP: 2,294 trillion U$ (7th in world)
Federative presidential republic
• Currency: Real = 0.5U$ (May 2012)
BRAZILIAN ORGAN TRANSPLANTATION LAW 9434 (1997)
•
Public
• Equity
• Justice
•Transparency
• Achieve population demand for
transplantation
• Regulatory for living and deceased
donation (no commerce/trafic)
•Presumed consent
ORGAN & TISSUE DONATION IN BRAZIL
•
•
•
•
•
•
•
•
•
National transplantation society: ABTO (since 1985)
National regulatory agency: SNT (created in 1997)
Regional regulatory agencies (CNCDO)
Regional OPOs* (according to state)
Intra-hospital transplant coordination (CIHDOTT)
Donation activity funded by the government (100%)
Organ transplantation: public (90%) or private (10%)
Allocation: single public waiting list
Regional allocation following pre-defined criteria
Brazilian Transplant System
Deceased organ donation by State in Brazil
(p.m.p.)
Source: ABTO - 2011
Deceased organ donation by State in Brazil
(p.m.p.)
ORGAN DONATION IN BRAZIL
IS LARGELY HETEREOGENEOUS
Source: ABTO - 2011
Scientific
Society
Government
Funding organ donation in Brazil
PROCUREMENT
RETRIEVAL
TRANSPLANT
3,000 R$
7,000 R$
100,000 R$
Tranplantation activity in Brazil
Period: Jan 1st – March 31st, 2012
Source: ABTO - 2012
ORGAN DONATION IN BRAZIL IS BASED ON
DECEASED DONORS
Source: ABTO - 2012
Referals 2011
Effective donors 2011
Referals 2012
Projected donors
2012
São Paulo
2495
793
672
292
1168
Minas Gerais
469
193
143
61
244
Rio de Janeiro
556
121
144
57
228
Rio G. do Sul
427
158
108
47
188
Santa Catarina
384
159
97
42
168
Ceara
373
148
84
36
144
Paraná
401
112
120
34
136
Bahia
374
69
104
27
108
Pernambuco
359
70
111
26
104
Dist. Federal
207
29
68
14
56
Espirito Santo
153
36
57
13
52
Rio G. do Norte
143
53
37
12
48
Pará
117
26
36
7
28
Goias
201
26
38
5
20
Paraíba
119
9
31
4
16
Rondonia
26
2
11
4
16
Amazonas
21
5
19
3
12
Sergipe
44
4
22
2
8
Mato Grosso Sul
115
11
36
1
4
Mato Grosso
66
6
18
1
4
Acre
11
4
11
1
4
Piauí
73
7
20
0
0
Maranhão
92
4
19
0
0
Alagoas
12
3
0
0
0
7238
2048
2006
689
2756
State
Total
Referals 2011
Referals 2012
Projected donors
2012
São Paulo
2495
793
672
292
1168
Minas Gerais
469
193
143
61
244
Rio de Janeiro
556
121
144
57
228
Rio G. do Sul
427
158
108
47
188
Santa Catarina
384
159
97
42
168
Ceara
373
148
84
36
144
Paraná
401
112
120
34
136
Bahia
374
69
104
27
108
Pernambuco
359
70
111
26
104
Dist. Federal
207
29
68
14
56
Espirito Santo
153
36
57
13
52
Rio G. do Norte
143
53
37
12
48
Pará
117
26
36
7
28
Goias
201
26
38
5
20
Paraíba
119
9
31
4
16
Rondonia
26
2
11
4
16
Amazonas
21
5
19
3
12
Sergipe
44
4
22
2
8
Mato Grosso Sul
115
11
36
1
4
Mato Grosso
66
6
18
1
4
Acre
11
4
11
1
4
Piauí
73
7
20
0
0
Maranhão
92
4
19
0
0
Alagoas
12
3
0
0
0
7238
2048
2006
689
2756
State
Total
Referals 2011
Referals 2012
Projected donors
2012
São Paulo
2495
793
672
292
1168
Minas Gerais
469
193
143
61
244
Rio de Janeiro
556
121
144
57
228
Rio G. do Sul
427
158
108
47
188
Santa Catarina
384
159
97
42
168
Ceara
373
148
84
36
144
Paraná
401
112
120
34
136
State
THERE ARE MANY OPPORTUNITIES TO
INCREASE ORGAN DONATION IN BRAZIL
Bahia
374
69
104
27
108
Pernambuco
359
70
111
26
104
Dist. Federal
207
29
68
14
56
Espirito Santo
153
36
57
13
52
Rio G. do Norte
143
53
37
12
48
Pará
117
26
36
7
28
Goias
201
26
38
5
20
Paraíba
119
9
31
4
16
Rondonia
26
2
11
4
16
Amazonas
21
5
19
3
12
Sergipe
44
4
22
2
8
Mato Grosso Sul
115
11
36
1
4
Mato Grosso
66
6
18
1
4
Acre
11
4
11
1
4
Piauí
73
7
20
0
0
Maranhão
92
4
19
0
0
Alagoas
12
3
0
0
0
7238
2048
2006
689
2756
Total
Intra-Hospital Transplant Coordinator (CIHDOTT)
Dialysis/outpatient clinics
blood
Patient referred
Transplant teams
Organ Procurement Organizations (OPOs) SPOT
HLA typing and crossmatch
Immunogenetics Labs
receptor
recipients
donors
Waiting list
Immunogenetics Labs
CNCDO
(Headquarters)
HLA
crossmatch
Organ allocation
Heart
Lung
Pancreas
Liver
Transplant teams
Follow-up results
Quality Control
Kidney
Kidney/Pancreas
ResolutionSS - 151, de 13-8-2010
Regional distribution criteria: São Paulo, Brazil
Corneas
 Regional waiting lists
- 4 regions
5 million
*
*
*
 Main distribution criteria:
Time on waiting list
5 million
10 million
*
*
*
*
*
 Priorities:
•
•
•
•
•
Primary non-function ( 90 days post-transplant)
Eye perforation
Descemetocele
Age < 7 yr. Old and bilateral cornea opacity
corneal ulcers w.o. Clinical treatment response
20 million
* Eye Banks
Courtesy of Dr. Reginaldo Boni
REFERRALS AND DONATION in SÃO PAULO, BRAZIL (1998 a 2010)
2800
2617
2456
2400
2307
notif ic aç ão
doador ef etivo
1965
2000
1719
1692
1607
1600
1419
1437
1533
1517
22,6 PMP 22,3 PMP
1191
1200
895
800
799
705
486
431
400
216
262
316
323
299
2000
2001
2002
342
332
376
376
2006
2007
0
1998
1999
Source: sistema estadual de transplantes
Obs. 2010 – projection (based on data from jan to april)
2003
2004
2005
2008
2009
2010
Referral, Donation and Transplanted organs
São Paulo, Brazil
2,9
2,9
2,9
2,9
2,9
2,8
2,9
2,7
*
Sociedade
Transplante
Doação
Extração
Dr. Luiz Augusto Pereira
transplant coordinator, São Paulo (1997-2012)
CENTRAL ESTADUAL DE TRANSPLANTES – SP
(São Paulo State Organ Donation Headquarters)
COORDINATION
MANAGEMENT
ORGAN WAITING LISTS
 MANAGES WAITING LISTS: HEART, LUNGS, LIVER, KIDNEYS,
PANCREAS AND TISSUES (CORNEA)
 REGULAR MEETINGS WITH TRANSPLANT TEAMS (REGULATORY)
 ELABORATES TECHNICAL NOTES AND PROTOCOLS
 INTERFACE WITH NATIONAL REGULATORY AGENCY (SNT)
 TRAINING TRANSPLANT CCOORDINATORS FROM OTHER STATES
(Acre, Sergipe, Goiás, Piauí, Mato Grosso – 2009/10)
ARCHIVES
DOCUMENTS
MANAGEMENT TISSUE WAITING LISTS  HUMAN RESOURCES TRAINING
 EVALUATION OF PATIENT WAITING LISTS
 SOFTWARE DEVELOPMENT
 PATIENT DATABASE HOSTING
TISSUE & ORGAN ALLOCATION
INFORMATION TECHNOLOGY
ORGANIZATIONAL MEETINGS
Procurement Organ Organization Santa Casa –
São Paulo
52 donors pmp/year
600
507
500
487
437
400
322
300
237
200
273
152
126
100
394
286
244
143
45
51
50
2002
2003
2004
199
192
113
116
33
36
2005
2006
173
148
420
186
470
390
161
117
62
0
Referal
2007
Donor
2008
2009
Organs
2010*
2011
Procurement Organ Organization Botucatu city UNESP – São Paulo
27 donors pmp/year
160
140
120
100
80
60
40
20
0
145
104
92
70
19
8
2005
Referal
28
9
2006
98
70
56
45
26
110
39
22
8
2007
11
19
2008
2009
5
Donors
9
35
50
16
2010
2011
Organs
2012
Nefrologia
População de Estado do RJ
IBGE – julho/2008:
15.872.362 habitantes
Total de municípios: 92
Total de centros de diálise
credenciados ao SUS (APAC): 66
Municípios que possuem centro de diálise: 29
CAN WE DO IT HERE?
New York State, USA
Population: 19.38 million
Rio de Janeiro State, Brazil
Population: 15,99 million
Organ donation in Rio de Janeiro
700
650
600
550
500
450
400
350
300
250
200
150
100
50
0
32,9
629
603
602
545
432
325
463
290
251
70
1998
64
1999
47
2000
72
80
107
91
101
39
33
2001
2002
Notification
2003
2004
Organ Donation
2005
2006
2007*
2009
2009
2009
RJ
4.4
2012
2009
RJ
4.4
2012
2009
RJ
4.4
2012
RJ
15
2009
RJ
4.4
SOMETHING IS HAPPENING
IN RIO DE JANEIRO!
2012
RJ
15
RJ
4.4
Orga donation in Rio de Janeiro
What’s going on…
Thomas Mone,
Global Leadership Symposium, 2010
Howard Nathan
Global Leadership Symposium, 2010
Nathan H, Global Leadership Symposium, 2010
U.S.S. Midway. San Diego,USA, 2010
U.S.S. Midway, 2010
State of the art lecture:
Strategies to increase organ donation in
Latin America and Brazil
TTS 2010 – Vancouver, Canada
FINAL REMARKS:
ONLY TIME WILL TELL WHETHER RIO DE
JANEIRO WILL SERVE AS A BENCHMARK
FOR ORGAN DONATION IN LATIN
AMERICA
Programa
Estadual de
Transplantes
(PET)
January, 2011
BRIDGING THE GAP: Translating Knowledge Into Powerful Action
New York State, USA
Population: 19.38 million
Rio de Janeiro State, Brazil
Population: 15,99 million
International cooperation: Creation of new OPOs
“American Model”
> 25,000 kidneys LifePorted for clinical Tx
> 100 transplant centers using LifePort WW
> 15 countries
 USA (> 50 customers, OPOs)
 Spain (Barcelona, Madrid)
 Portugal (Lisbon, Coimbra)
 UK (> 15 centers: Oxford, Cambridge, Kings)
 France (> 15 centers, several in Paris)
OPO’s Communication Center
Gift of Life, Philadelphia, USA
OPO surgical facilities
PET: organizational chart
PROGRAMA ESTADUAL DE TRANSPLANTES
Action Plan (2010)
• Build a new CNCDO (Headquarters)
• Create a friendly call center:
155
• Implant the “Spanish Model” of intra-hospital coordinators
• Increase reimboursement for transplant surgeries
• Apply a donor management tool (Donor Action)
• Habilitation for new transplant centers
• Open a public Eye Bank
• Increase general population awareness for organ donation
• Start an automated organ preservation program
• Overall training surgeons for organ harvesting
CAMARA DOS VEREADORES - ABRIL 2011
Programa Estadual de Transplantes
Launched in April 2010
Strategic plan based on 3 areas:
 professional training
 communication
 infrastruture
Main goal:
To increase organ & tissue donation in RJ state
 communication
 infrastruture
Main goal:
International cooperation:
UNIVERSITY OF BARCELONA (Catalunia, Spain)
Largest Professional Education Program
Courtesy of M. Manyalich, Spain
I Curso Avançado em Coordenação de
Transplantes
Petropolis, Rio de Janeiro, Brasil
SETEMBRO de 2010
Convênio com a Universidade de Barcelona
Curso “Transplant Procurement Manager”
2011
 communication
 infrastruture
Main goal:
193
DISQUETRANSPLANTE
155
Nº
Hospitais
Notificadores
de Potenciais
Doadores
Hospital
1
HEGV
2
HEAPN
3
HMSF
4
HMMC
5 H.Fer.Machado
6
HMSA
7
HFB
8
HEAL
9
HNMD
10
HSJA
11
HFA
12
H.N.SrªConc.
(Três Rios)
13
H.Stª Teresa
14
HSJB
15
HSE
16
H.Quinta D’or
17
HPM
18
HECC
19
HFAG
20
H.M.Resende
21
HCN
22
HEAT
23
HERF
24
H.Bombeiros
25
H.M.Moacir
Carmo
26
H.Pub.Macaé
27
HUPE
28
Norte D’or
29
IECAC
30
HCE
31
H. São Lucas
32
H.Barra D’or
Not Doação PCR
N.F
E.C
SCC SCG Doação s/
captação
72
50
35
26
25
18
14
13
13
12
11
10
19%
18%
14%
15%
24%
22%
14%
31%
16%
76%
27%
30%
45%
24%
34%
31%
16%
44%
43%
24%
30%
0
18%
10%
23%
32%
32%
19%
56%
22%
7%
31%
30%
8%
0
50%
4%
16%
17%
23%
4%
22%
29%
7%
8%
8%
37%
10%
4%
6%
3%
12%
0
0
7%
7%
8%
0
0
0
0
4%
0
0
0
0
0
0
0
0
9%
0
5%
0
0
0
0
0
0
0
8%
8%
9
0
10
10
10
9
8
8
7
7
6
6
6
5
5
30%
30%
0
0
25%
0
40%
29%
17%
17%
0
40%
20%
20%
10%
10%
12%
25%
38%
0
9%
33%
32%
66%
60%
40%
40%
40%
30%
44%
25%
24%
20%
43%
33%
17%
17%
0
0
10%
10%
60%
44%
0
38%
40%
9%
17%
17%
0
0
40%
0
0
0
0
25%
0
0
0
0
0
17%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10%
0
]
0
0
0
0
0
17%
0
0
0
5
5
4
4
4
4
4
20%
0
50%
25%
25%
25%
25%
40%
80%
0
25%
0
0
25%
20%
0
25%
0
75%
75%
50%
20%
20%
25%
25%
0
0
0
0
0
0
25%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Ano: 2011
Disque-transplante
155
 communication
 infrastruture
Main goal:
CNCDO
Central de Transplantes RJ
Volta Redonda Eye Bank
Opening new transplant centers
Hospital Quinta D’Or
Hospital São Vicente de Paulo
Hospital Adventista Silvestre
Hospital de Clínicas de Niterói
Estatística de doação de órgãos no RJ
período: 2009-2012
250
200
150
doadores
p.m.p.
100
50
0
2009
2010
2011
2012*
ano doadores p.m.p.
69
4,4
2009
80
5,1
2010
121
7,6
2011
222
13,9
2012*
Doações de órgãos efetivadas em 2010
PET
60
50
40
30
Notificações
Doações efetivadas
20
10
103
Dez
Nov
Out
Set
Ago
Jul
Jun
Mai
Abr
Mar
Fev
Jan
0
next steps
 Open a new eye bank
Goal: “Zero waiting”in cornea transplants
 Break the 20 p.m.p deceased donor barrier
 Increase number of organs harvested by
patient
Launch lung, pancreas & other tissues programs
ORGAN & TISSUE DONATION IN BRAZIL
SUMMARY
• Brazil has the largest public-funded transplant
program in the world
• Overall organ & tissue donation rates are improving
• Wide range of donation rates according to state
• Lack of standardization in management practices
• Lack of full-time dedicated professionals
• Great opportunity for improvement in most areas
Public awareness
Filme do governo
Realização:
Apoio:

Organ and Tissue Donation in Brazil

Transcrição

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